Brief report
Sleeping in? The impact of age and depressive sub-type on hypersomnia

https://doi.org/10.1016/j.jad.2005.10.004Get rights and content

Abstract

Background

While early morning wakening is held to be a classic feature of melancholia, we investigate the clinical observation that young patients with melancholia and bipolar depression tend to be more likely to report hypersomnia.

Methods

We examine age-related rates of those two sleep disturbance patterns in a consecutive set of out-patients with differing depressive sub-types assessed over a 20-year period.

Results

Hypersomnia was more likely to be reported than early morning wakening across all age bands by those with non-melancholic depression. Hypersomnia was also more likely than early morning wakening in younger patients with melancholia and bipolar disorder but, with age, early morning wakening became the dominant pattern.

Limitations

The study was retrospective, undertaken in a sample attending a tertiary referral unit and artefactual determinants of the associations were not pursued.

Conclusions

We speculate that hypersomnia may be a non-specific homeostatic coping response to stress and thus to the non-melancholic depressive disorders, but that this pattern is overruled by an early morning wakening pattern in the more biological depressive sub-types as the individual ages, perhaps reflecting a noradrenergic contribution.

Introduction

Terminal insomnia or early morning wakening is one of the so-called ‘endogeneity’ symptoms held to be over-represented in melancholic and psychotic depression. However, we have been struck clinically by the high likelihood of young people with melancholic depression reporting hypersomnia rather than early morning wakening. Similarly, while hypersomnia has long been described (Paykel et al., 1982) as a common ‘atypical’ feature in bipolar depression, we have been again struck by its high frequency in younger bipolar patients, perhaps reflecting the preponderance of melancholic (and psychotic) depression in those with bipolar disorder (Mitchell et al., 2001). Such observations led to the current study, where we sought to determine if hypersomnia was truly over-represented in young subjects with melancholic depression and bipolar disorder and, if so and more importantly, identify when any such sleep pattern might change to the more ‘typical’ pattern of early morning wakening.

Section snippets

Method and material

Data were derived from five consecutive samples of out-patients assessed from 1985 to 2004 at our tertiary referral Mood Disorders Unit, which is weighted to the assessment of those with severe and/or treatment resistant depressive disorders. While assessment was comprehensive, only details relevant to current study components are now provided. The psychiatrist assessed extensive self-report and interview data to make a clinical judgment about the likelihood of any lifetime Bipolar Disorder

Results

Our available sample numbered 1425 subjects across the five studies, with 1412 providing complete data on sleep variables. Inclusion criteria resulted in a sample of 345 patients reporting hypersomnia and 349 reporting early morning wakening (643 excluded for reporting neither or no sleep disturbance, and 88 for reporting both sleep patterns). After aggregating subjects into 10-year bands for their current age, there were relatively few occupying the older bands, so that we did not analyse data

Discussion

Reynolds and Kupfer (1987) observed that almost 90% of patients with a depressive illness suffer from nocturnal awakening, lengthening of sleep latency and early morning wakening. The cause and specificity of such changes are yet to be determined, however, associations with both severity of depression and with melancholia have been reported (Hubain et al., 1996, Stefos et al., 1998).

Description of hypersomnia as a feature of depression is not new, with Goodwin and Jamison (1990) noting that

Acknowledgments

We thank the NHMRC (Program Grant 2223708) and the NSW Centre for Mental Health for study support, and Institute colleagues for study assistance.

References (15)

There are more references available in the full text version of this article.

Cited by (32)

  • Sleep and Mood Disorders Among Youth

    2024, Psychiatric Clinics of North America
  • Circadian depression: A mood disorder phenotype

    2021, Neuroscience and Biobehavioral Reviews
  • Sleep and Mood Disorders Among Youth

    2021, Child and Adolescent Psychiatric Clinics of North America
    Citation Excerpt :

    In a sample of 8- to 11-year-olds with early onset bipolar spectrum disorders, 82% report having depression-related sleep problems, with initial insomnia being the most pervasive.38 Hypersomnia is also particularly salient in youth with bipolar disorder—a study by Parker and colleagues39 found hypersomnia to be present in 75% of patients with bipolar disorder younger than 25 years, but with increasing age, early morning awakening emerged as the dominant pattern instead. Additionally, major depression, as well as subsyndromal depression, during adolescence and prepuberty seems to precede the development of bipolar disorder in emerging adulthood—this association has been replicated in a variety of prospective and retrospective studies.40–42

  • Sleep in Major Depression

    2019, Handbook of Behavioral Neuroscience
    Citation Excerpt :

    Less frequent sleep complaints include hypersomnia (10%–15%), circadian sleep alterations, and disturbing nightmares (Argyropoulos & Wilson, 2005; Germain & Kupfer, 2008; Kaplan & Harvey, 2009; Waters, Moretto, & Dang-Vu, 2017). Hypersomnia appears to be more frequent in younger patients with depression and in bipolar depression (Parker, Malhi, Hadzi-Pavlovic, & Parker, 2006). From a sleep architecture point of view, major depression tends to present specific alterations that have been considered and recently reevaluated as biological markers of the disease (Palagini, Baglioni, Ciapparelli, Gemignani, & Riemann, 2013).

  • Napping and associated factors: A Japanese nationwide general population survey

    2016, Sleep Medicine
    Citation Excerpt :

    Moreover, an association between napping and depression has been reported [17,24,26]. It is known that patients with depression may exhibit hypersomnia symptoms [58,59]. The results of the present study suggest that the possibility of psychological stress should be taken into account when assessing long-duration napping.

View all citing articles on Scopus
View full text